Rafael Gonzalez, MD, fellow, Gynecologic Oncology, Duke University Medical Center, discussed unanswered questions about the cost-effectiveness of implementing frontline PARP inhibitor maintenance to all patients with advanced ovarian cancer, a topic of a recently released abstract from the 2020 Society of Gynecologic Oncology (SGO) Annual Meeting.
The idea of evaluating the cost-effectiveness of PARP inhibition in the frontline setting of advanced ovarian cancer was initially thought of prior to the release of the 3 clinical trials that demonstrated the efficacy of this strategy. Those studies include the phase III GOG-0218 study of bevacizumab (Avastin) monotherapy, the phase III SOLO-1 study of olaparib (Lynparza, NCT01844986), and the phase III PRIMA study of niraparib (Zejula, NCT02655016).
The overarching question was, is it cost-effective to treat all patients with advanced ovarian cancer, regardless of whether they harbor a BRCA1/2 mutation or have homologous recombination deficiency with PARP inhibitor maintenance following primary treatment.
In addition, there was a question around how much benefit would biomarker-negative patients need to derive to allow for the universal implementation of PARP inhibitor maintenance to be cost-effective.
The findings from the evaluation were that universal implementation of frontline PARP inhibitor maintenance is not cost-effective, but more focused strategies, such as only treating biomarker-positive patients, may be cost-effective.